KOOS KNEE SURVEY. Today s date: / /
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1 KOOS KNEE SURVEY Name: Today s date: / / Date of Birth: / / INSTRUCTIONS: This survey asks for your view about your knee. This information will help us keep track of how you feel about your knee and how well you are able to perform your usual activities. Answer every question by ticking the appropriate box, only one box for each question. If you are unsure about how to answer a question, please give the best answer you can. Symptoms These questions should be answered thinking of your knee symptoms during the last week. S1. Do you have swelling in your knee? S2. Do you feel grinding, hear clicking or any other type of noise when your knee moves? S3. Does your knee catch or hang up when moving? S4. Can you straighten your knee fully? Always Often Sometimes Rarely Never S5. Can you bend your knee fully? Always Often Sometimes Rarely Never 1
2 Stiffness The following questions concern the amount of joint stiffness you have experienced during the last week in your knee. Stiffness is a sensation of restriction or slowness in the ease with which you move your knee joint. S6. How severe is your knee joint stiffness after first wakening in the morning? S7. How severe is your knee stiffness after sitting, lying or resting later in the day? Pain P1. How often do you experience knee pain? Never Monthly Weekly Daily Always What amount of knee pain have you experienced the last week during the following activities? P2. Twisting/pivoting on your knee P3. Straightening knee fully P4. Bending knee fully? P5. Walking on flat surface P6. Going up or down stairs P7. At night while in bed 2
3 What amount of knee pain have you experienced the last week during the following activities? P8. Sitting or lying P9. Standing upright Function, daily living The following questions concern your physical function. By this we mean your ability to move around and to look after yourself. For each of the following activities please indicate the degree of difficulty you have experienced in the last week due to your knee. A1. Descending stairs A2. Ascending stairs A3. Rising from sitting A4. Standing A5. Bending to floor/pick up an object A6. Walking on flat surface A7. Getting in/out of car A8. Going shopping 3
4 For each of the following activities please indicate the degree of difficulty you have experienced in the last week due to your knee. A9. Putting on socks/stockings A10. Rising from bed A11. Taking off socks/stockings A12. Lying in bed (turning over, maintaining knee position) A13. Getting in/out of bath A14. Sitting A15. Getting on/off toilet A16. Heavy domestic duties (moving heavy boxes, scrubbing floors, etc) A17. Light domestic duties (cooking, dusting, etc) 4
5 Function, sports and recreational activities The following questions concern your physical function when being active on a higher level. The questions should be answered thinking of what degree of difficulty do you have experienced during the last week due to your knee. SP1. Squatting SP2. Running SP3. Jumping SP4. Twisting/pivoting on your injured knee SP5. Kneeling Quality of life Q1. How often are you aware of your knee problem? Q2. Have you modified your life style to avoid potentially damaging activities? Q3. How much are you troubled with lack of confidence in your knee? Q4. In general, how much difficulty do you have with your knee? Thank you very much for completing all the questions in this questionnaire. 5
KOOS KNEE SURVEY. These questions should be answered thinking of your knee symptoms during the last week.
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S6. How severe is your foot/ankle joint stiffness after first wakening in the morning? None (+0) Mild (+1) Moderate (+2) Severe (+3) Extreme (+4) ( )
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O 5-10 O O O >20 O <10 O O 0 O 1 O 2 O 3 O 4 O <5 O 6-9 O O 15
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